In the 2008 article by Sharon Dawe, Paul Harnett and Sally Frye Improving outcomes for children living in families with parental substance misuses: What do we know and what should we do, the authors provide insight into the research, sociological considerations, programs and community responses that may be of assistance whilst continuing to examine the issues and pose solutions.
They note that parents who misuse substances are likely to require help across many different areas of their family lives. This includes assistance with substance use, psychological problems and support with external stressors, such as housing and finances. Increasing social engagement of parents and their children in society in general was recommended. Interventions should aim to create the conditions that allow the parents to create a safe, nurturing and stimulating environment needed for the holistic development of children.
We know that child outcomes are influenced not just by parents, but the wider social ecology of families, neighbourhoods and society. The influences include the relationships between family members and factors within the social system such as the availability of social support, access to services and the presence of stressors such as poverty.
We also know that families facing multiple complexities have often had unsatisfying experiences with authorities and therefore mistrust health and welfare agencies. As such, engagement is key. If the situation of families with parental substance misuse is considered within the context of a model that argues for social determinants of health, then any attempt to improve outcomes for children needs to be viewed within a wider social context. Interventions are only likely to be successful in achieving positive psycho-social outcomes if they empower individuals, families and communities to become more autonomous participants in society.
The authors assert that there is no one simple or single solution. Any combination of problems may be hindering a parent in achieving their goals for change in the family. Consequently, there can be no fixed sequence of intervention strategies that will be relevant to all families. It is important to highlight the issues, look for the natural support network or provide support where gaps exist whilst also acknowledging the strengths of the family. Noting parental strengths and building on them add protective factors. These can include helping a distressed parent to be more emotionally available and more nurturing with their children. It can also involve helping the parent learn better child management skills. The wider social environment, in which poor housing, unemployment and social isolation are key factors, also influences children’s outcome. Real world issues such as these also need to be targeted in any treatment approach.
The authors further submit that governments need to ensure that the needs of children and families with parental substance misuse are prioritised in policy documents. In turn, treatment agencies and services need to have an organisational commitment to the provision of family-focused services. Practitioners need to be given support and receive ongoing supervision. Families will do best when they are engaged in treatment that they feel a part of, have a commitment to and believe they are working with the service to achieve common goals.
The few parenting programs evaluated that target substance-misusing parents reported promising results. These ecologically based programs target multiple levels of family functioning. The literature summarising the results of parenting programs that target discrete problems such as a child conduct problem provide some useful guidelines on the ingredients of effective parenting programs. However, the authors surmised that what works for families with a discrete problem may not be appropriate for families with problems across multiple domains of family functioning. Intensive interventions are needed.
In evaluating the effectiveness of intensive interventions with families affected by parental substance misuse, the authors found that for the most part, these studies involved parents who were already engaged in treatment services. They were all delivered by trained psychologists and the follow-up was relatively short (6 months). The findings from studies examining the effectiveness of intensive interventions with families affected by parental substance misuse are promising. However, caution is recommended, as there is a need for further research to determine if the programs create enduring change.
A review of parenting programs targeting discrete family problems found that the studies that provided both parent training and supplemental services such as anger or stress management, substance abuse treatment or job skills training did not have as large an effect on child behaviour as those programs where parenting training was a stand-alone intervention. This raises the question as to whether the ancillary services either distracted parents from the key task of learning parenting skills or whether the additional focus on other areas meant that there was less time spent on parenting skills. Limits to this analysis led to a call for more research in the area.
The importance of having an organisational commitment to the development of family-focused interventions was emphasised. It is essential that there is organisational support that will ensure that good quality and sustainable services are provided for families with parental substance misuse. Quality staff training and a clear model of intervention and regular professional regular supervision were also highlighted.
A clear mandate or policy directive to enable a flow-on effect through which funding would flow to organisations that positioned themselves to undertake such work was viewed as essential. The authors noted that unless there is clear policy that provides a strong mandate for treatment providers to consider the importance of family-focused interventions, any attempt by agencies or organisations to address the needs of children and families will be ad hoc.
Clearly, highlighting the needs of children in substance abusing families at a policy level will not directly translate into adequate service provision. But without the inclusion of children and families in drug and alcohol policy, the chance of ensuring that quality, evidence-based treatment develops in a sustainable manner is limited.
The review of a large body of parent training literature points to several components that seem to be important in producing change. The extent to which programs should target multiple domains in multi-problem families is a complex one. Simply adding services to a program that was designed to target a discrete family problem does not appear to improve its effectiveness. Rather, the rationale and framework of an ecologically informed program may well be critical for achieving success. It is likely that the procedures for engaging the family, providing a rationale for the intervention, and developing a trusting working alliance is critical for successful outcomes.
Overall the authors found that whilst there were positive inroads in treatment programs offered more research was required to fully ascertain what works and what doesn’t when assessing the needs of children in families where drug misuse is present.
Since this article, Professor Sharon Dawe has undertaken considerable research and made significant contributions to knowledge in this field on parental substance use. This is particularly so for methamphetamine ‘ice’ usage. Professor Dawe will be a keynote speaker at our upcoming Just Ice? Symposium on Thursday 3rd and Friday 4th August . Her topic will be Assessing the impact of ice on families using the integrated theoretical framework about the impact on children. This presentation involves looking at child outcomes as dependent on the parent’s state of mind.
For more research by Professor Sharon Dawe:
Chamberlain, K., Reid, N., Warner, J., Shelton, D., & Dawe, S. (2016). A qualitative evaluation of caregivers experiences, understanding and outcomes following diagnosis of FASD. Research in Developmental Disabilities, 1–8.
Cooper, A. J., Stirling, S., Dawe, S., Pugnaghi, G., & Corr, P. (2016). The reinforcement sensitivity theory of personality in children: A new questionnaire. Personality and Individual Differences, 1–5.
McKetin, R., Dawe, S., Burns, R. A., Hides, L., Kavanagh, D. J., Teeson, M., … Saunders, J. B. (2016). The profile of psychiatric symptoms exacerbated by methamphetamine use. Drug and Alcohol Dependence, 161, 104–109.